Heart failure monitor quicklook summary for patient management systems

ABSTRACT

Continuous remote monitoring of patients based on data obtained from an implantable hemodynamic monitor provides an interactive patient management system. Using network systems, patients are remotely monitored to continuously diagnose and treat heart-failure conditions. A screen displayable summary provides continuous feedback and information to physicians, patients and authorized third parties. The quick look summary includes various sites and presentation tailored to match the patients&#39; and physicians&#39; needs. The quick look summary further includes intelligent features that understand and retain the user&#39;s interests, preferences and use patterns. Patients, physicians and other caregivers are seamlessly connected to monitor and serve the chronic needs of heart-failure patients in a reliable and economic manner.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.12/897,113, filed Oct. 4, 2010, now U.S. Pat. No. 8,078,270 now allowed,a divisional of U.S. application Ser. No. 10/612,856 filed Jul. 3, 2003,now U.S. Pat. No. 7,831,301 which is a divisional of U.S. applicationSer. No. 09/809,915 filed Mar. 16, 2001, now U.S. Pat. No. 6,599,250,which claims the benefit of U.S. provisional application No. 60/190,272,filed Mar. 17, 2000.

FIELD OF THE INVENTION

The present invention relates to implantable hemodynamic monitors(IHMs). Specifically, the invention relates to systems that interfacewith various hospital monitoring systems to transfer data from the IHMsto doctors and other data processing centers. More specifically, theinvention pertains to heart failure data management systems that providea concise and reliable summary view of information in a manner that isuseful for clinicians and health care personnel to monitor, assess,evaluate and treat heart failure conditions in patients. Further, theinvention pertains to a system of a bi-directional communication systemthat is network, Internet, intranet and worldwide web compatible toenable chronic monitoring based on data obtained from the IHMs.

BACKGROUND OF THE INVENTION

The need to monitor, on a frequent and continuous basis, the vital signsassociated with hospitalized patients particularly those who areseriously ill is an important aspect of health care. Virtually everyhospitalized patient requires periodic measurement in logging of bloodpressure, temperature, pulse rate, etc. Such monitoring has typicallybeen performed by having a health care worker periodically visit thebedside of the patient and measuring and/or observing the patient'svital signs using dedicated equipment that is either hooked up to thepatient or brought into the patient's room. Such a monitoring procedureis not ideally cost-effective because of its being highly laborintensive.

A great many implantable medical devices (IMDs) for cardiac monitoringand/or therapy whose sensors are located in a blood vessel or heartchamber and coupled to an implantable monitor or therapy delivery deviceare used for diagnosis and therapy. Such systems include, for example,implantable heart monitors, therapy delivery devices, and drug deliverydevices. All these systems include electrodes for sensing and senseamplifiers for recording and/or deriving sense event signals from theintracardiac electrogram (EGM). In current cardiac IMDs that provide atherapy, sensed event signals are used to control the delivery of thetherapy in accordance with an operating algorithm. Selected EGM signalsegments and sensed event histogram data or the like are stored in aninternal RAM for telemetry to be transmitted to an external programmerat a later time. Efforts have also been underway for many years todevelop implantable physiologic signal transducers and sensors fortemporary or chronic use in a body organ or vessel usable with such IHMsfor monitoring a physiologic condition other than, or in addition to,the disease state that is to be controlled by a therapy delivered by theIMD.

A comprehensive listing of implantable therapy devices are disclosed inconjunction with implantable sensors for sensing a wide variety ofcardiac physiologic signals in U.S. Pat. No. 5,330,505, incorporatedherein in its entirety by this reference.

Typically, an IHM measures blood pressure and temperature signal valueswhich stem from changes in cardiac output that may be caused by cardiacfailure, ventricular tachycardia, flutter or fibrillation. Thesevariations may reflect a change in the body's need for oxygenated blood.For example, monitoring of a substantial drop in blood pressure in aheart chamber, particularly the right ventricle, along or in conjunctionwith an accelerated or chaotic EGM, was proposed as an indicator of afibrillation or tachycardia sufficient to trigger automatic delivery ofdefibrillation or cardioversion shock. More recently, it has beenproposed to monitor the changes in blood pressure by comparing thosevalues that accompany the normal heart contraction and relaxation tothose that occur during high-rate tachycardia, flutter or fibrillation.

A number of cardiac pacing systems and algorithms for processingmonitored mean blood pressure or monitored dp/dt have been proposed andin some instances employed clinically for treating bradycardia. Suchsystems and algorithms are designed to sense and respond to mean ordp/dt changes in blood pressure to change the cardiac pacing ratebetween an upper and a lower pacing rate limit in order to controlcardiac output. Examples of IHMs blood pressure and temperature sensorsthat derive absolute blood pressure signals and temperature signals aredisclosed in commonly assigned U.S. Pat. Nos. 5,368,040, 5,535,752 and5,564,434, and in U.S. Pat. No. 4,791,931, all incorporated by referenceherein.

The Medtronic® Chronicle™ Implantable Hemodynamic Monitor (IHM)disclosed in U.S. Pat. Nos. 6,024,704 and 6,152,885, both incorporatedherein by reference in their totality, employ the leads and circuitrydisclosed in the above-incorporated commonly assigned U.S. Pat. Nos.5,535,752 and 5,564,434 patents to record absolute blood pressure valuesfor certain intervals. The recorded data is transmitted to a programmerunder the control of a physician in an uplink telemetry transmissionfrom the IHM during a telemetry session initiated by downlink telemetrytransmission from the programmer's radio frequency (RF) head and receiptof an integration command by the IHM. Thus, in accordance to the '704and '885 patents, a method is disclosed in which an IHM is used forderiving reference and absolute pressure signal values using implantablephysiologic sensors to detect relative cardiac pressure signal valuesfor storage and transmission.

Further, in accordance with the '704 and '885 patents, calibration ofthe reference pressure and/or temperature sensors in relation to anexternal calibrated barometric pressure and/or body temperature sensorscould be accomplished. In addition, the same system may be used tointerlace digital signal values related to pulmonary artery diastolicpressures with the primary cardiac pressure signal values derived fromthe right ventricle as disclosed in U.S. Pat. No. 6,155,267,incorporated herein by reference.

Heart failure is a progressive disease. While treatment slows theprogression of the disease, current technology does not provide a cure.The best treatment regimen available to date is a combination ofcontinuous diagnosis and drug therapy. Once a heart failure patient isin the hospital, current technology does not provide a continuous meansof monitoring the patient during their stay in the hospital. Currentpractice is based on a dedicated programmer that is used to gain accessto the pressure waveforms. Only trained physicians can currently uplinkthe data, and this is available only when such a trained physician ispresent, and is therefore not available on a continuous basis.

The present invention enables continuous remote monitoring of patients.In sharp contrast, prior heart failure management involves takingmeasurements of a few variables in the clinic with accuratecatheterization pressures taken only occasionally because of thedifficulty of obtaining them.

Accordingly, there is a need to provide continuous and reliablemeasurements over sustained long period of time. Further, emergingtrends in health care including remote patient management systemsrequire that the IMD/IHM be compatible with communication systems,including the Internet, the worldwide web, and similar systems toprovide real-time communications and data exchange between the IHM in apatient and a remote center where physicians and other experts reside.

SUMMARY OF THE INVENTION

The present invention relates to chronic data management for cardiacsystems. Specifically, the invention pertains to IHMs that monitor heartfailure. In its broader aspect, the invention relates to patientmanagement that enables the collection of chronic data for remotepatient management, including remote delivery of clinical diagnosis andtherapy.

Yet another aspect of the invention includes a user-friendlyscreen-displayable data management system that presents clinicallyrelevant measurements. Another aspect of the invention provides asoftware system that enables the translation and transposition of IHMcollected data to be presented to a clinician in a manner to enableefficient and reliable evaluation of patient conditions remotely.

The invention further relates to data reduction in a monitoring systemas generally disclosed in co-pending application entitled “ImplantableMedical Devices Monitoring Method and System Regarding Same” filed onDec. 15, 1999, U.S. Application Ser. No. 09/992,978, incorporated hereinby reference in its entirety.

The present invention, inter alia, enables the transfer of a patient'smedical data to one or more monitoring stations staffed by expertpersonnel to have access to the data in real time. Although the IHMdevice implemented in the present invention relates to the measurementof cardiac pressure, other IHM devices that detect and transmitadditional physiological signals such as oxygen saturation, pulmonaryartery diastolic and systolic pressure, temperature and related data maybe used as the originating device or data source. Transferring real-timesignals from IHMs to various physician portals and locations provides ahighly accentuated medical service and effective chronic monitoring ofpatients.

In one aspect of the present invention an IHM device determines thehemodynamic status of a patient from measurement of pulmonary pressureand right atrial pressure obtained from a single absolute pressuresensor implanted in the right ventricle. Both of these values have beenshown to correlate to the degree and extent of cardiac failure of apatient. The IHM continually monitors the right ventricular pressureusing an absolute pressure sensor and marks the right ventricularpressure at the moment of specific events.

One aspect of the present invention is to provide a means by whichphysicians could view data available via real-time telemetry other thanusing a local data retrieving system, such as a programmer. Currently,physicians use the programmer to view the real-time pressure wave alongwith the EGM tracing. Using the present invention, the IHM device wouldbe able to telemeter real time signals to a system via a programmer orother instrument to a remote location.

Another aspect of the present invention relates to the presentation ofdata from IHMs in a summary view that's useful and familiar toclinicians and patients. Yet another aspect of the present inventionincludes a process by which data is collected by IHMs, which dataincludes but is not limited to heart rate patient activity and pressuredata, to establish that the patient is in a state of repeatable dataroutine on a daily basis. For example, this might mean application of amagnet when the patient is lying down, or using devices such astime-of-day counters, activity sensors, posture sensors, etc. Such datais retrieved for analysis via home monitors, programmers or similardevices, and the data sent over an Internet/intranet, worldwide web or asimilar network to a remote location for analysis by clinicians or forstorage and archiving at a Medtronic server.

The data is processed for collection with past pull-up records tocompose a continuous patient record. Specifically, clinically relevantmeasurements are pulled out of the data. This would mean observing theaverage values measured during a daily test, including, for example, thepatient reclining for 5 minutes. These values and the deviation orchange are compared against clinical norms and flagged for the user ifthey are abnormal. For example, color plus footnote designations may beused to identify or flag abnormal data. Other variations such asitalics, specialized fonts, bigger fonts, e-mail reports, faxed reportsmay be used to identify deviations from normal clinical data orestablished chronological data for the patient. The clinical norms canoptionally be modified for each patient by the clinician and then serveas a clinical baseline for the particular patient.

One other aspect of the present invention is the display of data whichwithout limitation, includes the most recent daily test data along withdata from the previously interrogated data. A comparative value betweenthe two and a previous interrogation date to compare collected data withchronological data are used.

Yet another aspect of the present invention includes a single page viewof chronic heart failure status, translation of raw data into clinicalindicators of heart failure status, analysis of changes in indicatorsover a user-selectable time period, flags and indicators to identifychanges that are outside of clinical norms, tailoring of graphicaldisplays and data management to a patient's clinical norms, means todetermine if the patient is in a state of repeatable condition from dayto day, and automated data analysis triaging which provides a foundationfor further data analysis and automation.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A shows a diagram illustrating an implantable medical device thatincorporates an absolute cardiac blood pressure sensor and an IHM devicein accordance with the present invention.

FIG. 1B is a block diagram illustrating various data communicationsystems from the IMD.

FIG. 1C is a block diagram illustrating signal transmission from the IMDto a remote station.

FIG. 2 is a block diagram illustrating the remote communication systemwithin which the present invention is incorporated.

FIG. 3 is a block diagram representing a web browser and portalinterface for the present invention.

FIG. 4A is a block diagram representation illustrating a Medtronic homepage at the Medtronic server in which data may be archived in accordancewith the present invention.

FIG. 4B is a logic flowchart representing high level quick look summaryin accordance with the present invention.

FIG. 5A is a representative sample of a welcome screen.

FIG. 5B is a representative hemodynamic variables display screen.

FIGS. 6 & 7 is a quick look summary in accordance with the presentinvention.

FIG. 8 is a representative screen for a trends report.

FIG. 9 is a representative screen for a trends report similar to FIG. 8.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

FIG. 1A represents a patient with implanted medical device incorporatingan absolute cardiac blood pressure sensor such as the IHM discussedhereinabove. Specifically, IHM/IMD 100 is coupled to an absolute cardiacblood pressure sensor 120 in a patient's heart 10 for recording absoluteblood pressure values. IMD 100 is depicted implanted subcutaneously inthe patient's chest region and it is coupled at its connector module 180to a lead 112 extending through blood vessels into the right ventricleof the patient's heart 10. The blood pressure sensor 120 is located onlead 112 just proximal to the lead's distal tip 130 for passively fixingit in position to accommodate continuous movement of the heart 10. Inthis structure lead 112 and blood pressure sensor 120 correspond tothose disclosed in detail in the above-incorporated commonly assigned'434 and '752 patents for deriving absolute blood pressure. The IMD 100that monitors the physiological condition or state is programmableand/or can be interrogated by an external instrument such as aprogrammer through the use of bi-directional or RF telemetry thatexchanges data and commands via uplink and downlink RF telemetrytransmissions through the patient's skin.

In the context of an implantable blood pressure monitor a series ofabsolute blood pressure signal values are sensed periodically or inresponse to a signal provided by hospital personnel for example, atelemetry downlink signal to initiate real time data transmission. Theabsolute blood pressure value signals are continuously transmitted sothat physicians, clinicians, nurses or other medical experts candetermine the status of the patient's cardiac pressures and associatedepisodes recorded within the required time of day. The physician uses anexternal programmer to generate and transmit an interrogation commandvia a downlink telemetry transmission to the IMD 100. IMD 100 recognizesthe command and initiates a continuous uplink telemetry transmission ofthe absolute pressure data in response. The uplink telemetry continuesuntil the IMD system fails to detect further commands.

FIG. 1B illustrates a general scheme by which patient data could betransmitted to a remote clinician's station. The communication schemeenables continuous monitoring of patients either in a hospital settingor in a home environment. Pressure signals are acquired from the IMD viatelemetry head 22 or equivalent device and uplinked to instrument 24.Instrument 24 may represent a programmer or an in-home monitor adaptedto communicate with IMD 20. Instrument 24 maintains wirelesscommunication 27 to transfer data to clinician's station 28.Alternatively, instrument 24 may be adapted to transfer data via network30 representing Internet, extranet, worldwide web or a similar network.The data is then transferred to clinician's station via modem, cable orequivalent data transfer system.

FIG. 2 represents a detailed aspect of network 30 that is accessible topatients and physicians within which search engine 40 enables access tovarious zones 42, including a dedicated public zone 44, confidentialzone 46 and private zone 48. These zones represent various datamanagement centers that are either interconnected or segregated based onprivacy and security requirements. For example, public zone 44 isaccessible to all patients, physicians and the public to provide generalinformation about medical devices and related medical information andservices. In sharp contract, confidential database 46 and privateinformation 48 are accessible to patients and physicians based on strictsecurity and encryption systems for access on a need-to-know basis.

Referring now to FIG. 3, web browser and portal interface 50representing patient portal 52, physician portal 54 and Medtronic (MDT)portal 56 are shown. These portals share a common database withadditional secure database 58 and encryption system 60 interconnectedtherewith.

FIG. 4A is a general representation of a Medtronic home page 70 inaccordance with the present invention. The home page is segregatedbetween public and private/secure pages. Specifically, a physiciansection, patient section and a general public information section aredepicted. The physician's section is highly scalable and operates bothon the public and private secure sections. Similarly, the patientsection relates to information on various medical devices includingrelated therapy and diagnosis. Further, similar to the physician's site,the patient site includes private/confidential segments.

FIG. 4B represents a general logic flow diagram for a quick look summaryin accordance with the present invention. Specifically, the system isinitiated under logic step 80 where long-term data is collected via IMD100. The long-term data is refined to determine if the patient is in arepeatable state under logic step 82. Subsequently, the data isretrieved and processed under logic step 84. Thereafter, under decisionstep 86 the values of the processed data are reviewed to see if they areabnormal. If these values prove to be abnormal, they are flagged asabnormal values under logic step 88 and the results are displayed underlogic step 90. In the alternate, if the values are found to be normal,they are displayed under logic step 90. One of the significant aspectsof the present invention is the presentation of highly user-friendlyquick look summary of data collected by IMD/IHM 100 to clinicians,patients and other health providers.

Referring now to FIG. 5A, a representative screen encountered by adoctor using the Internet site provided in accordance with the presentinvention is shown. Specifically, the screen includes various tabs, oneof which is to welcome the user. The welcome screen identifies thedoctor and updates him or her on how many home monitoring records havebeen reviewed and how many abnormal events have been detected. Thedoctor is also informed of the number of patients who may requirereview. The doctor is also given various information regarding his orher practice and is also informed on what is new in the art vis a visspecific devices and medical conditions. The screen is highlyinteractive and based on past site use behavior of the doctor, thesoftware is able to understand and retain the doctor's interests andhighlight unused features.

In the “What is New” section, for instance, the screen interactivelyprovides the doctor with the latest information regarding clinicalstudies including the devices that are released in the user's countries.The “Links” section provides links to related medical sites. The list oflinks is maintained by Medtronic, so only approved sites will appear.The list of potential links is narrowed by the user's areas of interest.Clinicians can also provide recommended links to their patients. Thiswill appear in the patient portal and are customized by the recommendedlinks, the type of devices the patient has implanted, the local languageto be used and a track record of previous links that have been used.

Further, patient records of device and recorded data will be availablefor viewing and entry. This data may have been collected by homemonitors, programmers, extenders, registration database or imported fromclinic databases. Users can arrange the view of records, listable totheir liking by date, name, ID and status. Specifically, statusindicators are used for home monitoring data yet to be viewed or witherrors. The records may include in-office follow-up test results,interrogated diagnostic data settings and measurements, data importedfrom pacing databases such as EKG indication, medications includingcontrol of compliance, monitoring functions, key physiologic data suchas indications for implant, links to other online components of apatient's chart such as lab results, notes entered, data integratedacross patient sessions such as episode logs and trends, patientdemographics and patient diary entries.

The system may also be customized based on whether the portal is used tostore in-home or programmer records for the particular patient. Allparts of the patient's records that are attributable to the patient areclearly patient private data. Encryption and adequate authenticationmust be used for access. Attribution of who enters and edits changes isalso supported by the system software.

Appointment scheduling provides an automatic means for schedulinghome-monitoring sessions so home monitoring could be conducted withoutadditional burden on the clinic scheduling staff Physicians may entertheir prescribed follow-up intervals and then the system can schedulethe follow-up days. Patients can customize their schedule without thehelp of the clinical staff. The scheduling may also integrate with theclinic's in-office scheduling enabling doctor appointments to be madeonline.

Accounts billing are automated. Automation of the filling out of billingstatements is also provided. Medical device follow-up regiments canoften automatically be determined from session data. The data isforwarded to the clinician's billing system or a third party billingclearing house. Medtronic device registration forms will be web-enabled.Direct entry on the web or import from un-tethered data entryapplications will be supported. Entry on the web will enable access bycustomers rather than field representatives without the highdistribution and support cost encountered today with PC applications.

Clinical study content will be available to clinical studyinvestigators. This could include entry of clinical data forms,discussion groups, newsletter and results reports. The site iscustomized based on which studies the user is a part of and the locallanguage used. Physicians can compare their practice by comparing theirpractice data to data aggregated from other practices and practiceguidelines. Specific comparison and points can be offered with customfilters. Eventually data mining may be offered. This will include andexpand on the current capabilities of the CV views extranetapplications. This part of the site could be customized based oncollected user's data that is also made available for comparisons.Further, information about the user's practice to derive comparisondefinitions, for example with other practitioners in the area ofexpertise may be provided.

The site also includes reports for tracking product performance and willmaintain tags on the referring physician. The distribution of reports isgreatly enhanced through web-enabled features. Specifically, the contentis tailored to each practice. For example, product performance can beincorporated with web devices such as a palm device which may be on theperson of the patient or the physician. Similarly, the accuracy ofreports can be enhanced by joining data. For example, closer monitoringreports may contain more accurate battery projections derived fromfollow-up and continuous monitoring of actual device data.

The system enables remote viewing. Specifically, users can remotely viewpatient stations through instruments connected to the Internet 30.Sessions with programmers, extenders, acute monitors and home monitorswill be viewed through web browsers or a PC. Users will have access to aswitchboard of available instruments they have rights to connect to andaccess the contents thereof. The connection is supported in any orderwhether it is browser or instrument first. Preferably, the site iscustomized by identifying which instruments the user has access rightsto. Rights are assigned to physicians and clinical personnel as needed.

In the same manner, the link for patient portal 52 is a secure websitefor patients already implanted with Medtronic devices and theirfamilies. It includes the web content that requires secure access notavailable in the Medtronic public website 56. Patient portal 52 providespersonalization, automatically providing only the information pertinentto the patient's device and disease. This is combined with a consistentuser interface for the diverse applications being provided for a highlydistributed user-friendly web experience.

Welcome screen 155 of FIG. 5A highlights important information with moredetailed features. The site is customized by patient's names, whatdevices the patient has implanted, marketing preferences of what news ornew products are of interest, physician control of what the patient hasaccess to, past portal use to understand interests and highlight unusedfeatures, and what local language the patient uses.

One of the significant aspects of this site includes a home monitoringsection which closes the loop for home-monitored patients. Thesepatients can view whether sessions were successful or trouble-shooterrors. They can gain reassurance by viewing high-level results. Clearlythis will reduce the burden of phone calls on clinicians. The site iscustomized by results of home monitoring sessions. The type of implanteddevice and home monitor that are proper to a patient are generallydecisions made by the patient's physician. For security reasonshome-monitoring results may be considered patient private data and willrequire encryption and user authentication. The site also providesappointment scheduling in which an automated means for schedulinghome-monitoring sessions is implemented without additional burden onclinic scheduling staff. Physicians can enter their prescribed follow-upintervals and the system is intelligent to schedule the follow-up days.Patients can customize their schedule without the help of the clinicalstaff. The scheduling may also integrate with a clinic's in-officescheduling enabling doctor appointments to be made online.

Patient portal 52 also includes a diary section where daily medicaljournal entries can be captured. Voice or text can be captured either onthe diary screen or potentially on a home monitor. Regardless of whereit is entered, the diary screens would provide options to review andedit the contents of a diary. By putting the diary online, it isinstantly available to all medical caregivers. Further, the diary doesnot need transcription or transfers to become part of a medical chartbecause of automatic entry.

Yet another significant aspect of the screen display at patient portal52 includes the management of patient ID cards. Requests forreplacements and validation of patient's information is automated onpatient portal 52. Patients can also print out replacement ID cards foruse while the processing of a permanent card is in progress. Patientportal 52 also enables patients to control the rights to their records.Specifically, patients will have rights to grant control and accessrights to their records as they may deem necessary.

Referring to FIG. 5B, a quick look summary of hemodynamic variables 125is represented. The screen provides one-week trends for hemodynamicvariables RV pressure waves. For example, triggered episodes could beselected under a tachy-, brady- or patient-triggered events. Atachy-triggered event, for example, would inform the user if the patienthas tachy-triggered events. Similarly, a brady-triggered event informsthe user if the patient has brady-triggered events. Further,patient-triggered events relate to information indicatingpatient-triggered events.

Referring to FIG. 6, quick look summary screen 140 represents variousparameters useful to determine a tachy or brady trigger. A tachy-triggernotification informs the user if the patient has tachy-triggered events.If there are tachy-triggered events the device information network forexample, IHM 100, will notify the designated person, for instance anurse, doctor or health provider electronically that events haveoccurred by e-mail, pager or other means. Similarly, a brady-triggerednotification would be dispatched in the event there are brady-triggeredevents. IHM 100 will notify the designated person about the event.Patient-triggered notification is also dispatched in the same manner.

Referring to FIG. 7, under display screen 150, the software systemenables analysis of comparative values based on a comparison of recentvalues to values interrogated on a prior time period. Patient portal 52and physician portal 54 provide various ways of presenting clinicalinformation. Specifically, daily minimums of heart rate for quick look,RV systolic pressure, daily minimums of RV diastolic pressure, dailyminimums of estimated pulmonary artery pressure, daily minimums of RVpulse pressure, daily minimums of RV dp/dt, highlighting out-of-rangeheart rate, highlighting out-of-range RV systolic pressure, highlightingout-of-range RV diastolic pressure, highlighting out-of-range ePADpressure, highlighting out-of-range RV pulse pressure, highlightingout-of-range RV dp/dt, notification of heart rate out-of-range,notification of RV systolic pressure out-of range, notification of RVdiastolic pressure, notification of ePAD pressure, notification of RVpulse pressure, notification of RV dp/dt out-of-range, highlightingchanges in heart rate. Specifically, the quick look will determine andreport changes in heart rate which have occurred in a patient betweenthe daily minimum values contained in the file selected for examinationand the daily minimum values from a previous file. More specifically,values are compared to determine if the differences lie outside auser-defined threshold is defined in the quick look setup and can betailored on a patient-by-patient basis. This feature allows the user todefine differences either based on actual values or percentages.Highlighting changes in RV systolic pressure relates to pressures whichhave occurred in a patient between the daily minimum values contained inthe file selected for examination and the daily minimum values from aprevious file.

Highlighting changes in RV diastolic pressure enables the quick look todetermine and report changes in RV diastolic pressure which haveoccurred in a patient between the daily minimum values contained in thefile selected for examination and the daily minimum values from aprevious file. Similarly, the quick look will determine and reportchanges in RV pulse pressure which have occurred in a patient betweenthe daily minimum values contained in the file selected for examinationand the daily minimum values from a previous file. Highlighting changesin RV dp/dt includes determination and reporting of changes in RV dp/dtwhich have occurred in the patient between the daily minimum valuescontained in the file selected for examination and the daily minimumvalues from a previous file. Notification of large heart rate change isimplemented by enabling IHM 100 information network to notify adesignated person electronically that changes in heart rate greater thanset targets have occurred. A notification may be sent by e-mail, pagerand an equivalent medium.

Similar notification of large RV systolic pressure changes, large RVdiastolic pressure changes, large ePAD pressure changes, large RV pulsepressure change, and RV dp/dt changes may be made. The quick look allowsthe user to select from a list of previous files. A specific file may beselected for data against which the current file is compared todetermine if hemodynamic values have changed. Accordingly, quick lookcompares the daily minimum values from the selected file set of previousfiles to show the user variation that may have occurred. Additionally,while the quick look page allows the user to examine a selected file,its comparison to threshold values and comparison to a previous file, italso provides the daily minimum plots to enable the user to see atime/trend plot of all daily minimum values for all variables. Further,a daily minimum list may be used to examine a selected file, itscomparison to threshold values and its comparison to a previous file tosee a listing of all daily minimum values for all variables.

Referring now to FIGS. 8 and 9, trends report 160 and 170 arerepresented. Specifically, heart rate, patient activity, systolic anddiastolic pressures and similar cardiac/physiologic parameters collectedover a period of several weeks. Trend reports for night heart rate,+dp/dt and −dp/dt including pre-ejection systolic time intervals may bedisplayed. Trend directions for 12 months to 1 hour may be selected forreview.

The preceding specific embodiments are illustrative of the practice ofthe invention. It is to be understood, therefore, that other expedientsknown to those of skill in the art or disclosed herein may be employedwithout departing from the invention or the scope of the appended claim.It is therefore to be understood that the invention may be practicedotherwise than is specifically described, without departing from thescope of the present invention. As to every element, it may be replacedby any one of infinite equivalent alternatives, only some of which aredisclosed in the specification.

1. A system for monitoring hemodynamic status of a patient, the systemcomprising: an implantable hemodynamic monitor (IHM) recording pulmonaryartery pressure data of the patient; an interface to interrogate the IHMand retrieve the data of the patient; means for transferring theretrieved data to a remote data center location having a web server; aprocessor to detect an abnormal event from the patient data relating topulmonary artery pressure of the patient; and a portal interfaceincluding a browser providing access to the retrieved data over anetwork via the web server at the remote data center location, theportal interface providing access to a viewable summary display pagedisplaying whether an abnormal event was detected.
 2. The system ofclaim 1 wherein said hemodynamic patient data comprises blood pressurevalues.
 3. The system of claim 1 wherein said network comprises aworldwide web, Internet connection.
 4. The system of claim 1 whereinsaid remote location includes a database server accessed through the webserver.
 5. The system of claim 1 wherein said web server is accessibleto patients and physicians via the portal interface.
 6. The system ofclaim 1 said web server enables access to various zones including adedicated public zone, confidential zone and a private zone.
 7. Thesystem of claim 1 wherein the portal interface providing access to aviewable summary display page comprising pulmonary artery pressure viathe web server.
 8. The system of claim 7 wherein the summary displaycomprising a display of trends in the retrieved data.
 9. The system ofclaim 1 wherein the portal interface providing access to a plurality ofpages segregated between public and private pages and comprising: aphysician section operating on both the public and the private pages, apublic section operating only on the public pages, and a patient sectionoperating on both the public and the private pages.